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PubMed2002

Increased neonatal mortality in mice lacking cellular retinol-binding protein II.

Cellular retinol-binding protein II (CRBP II) is a member of the cellular retinol-binding protein family, which is expressed primarily in the small intestine. To investigate the physiological role of CRBP II, the gene encoding CRBP II was inactivated. The saturable component of intestinal retinol uptake is impaired in CRBP II(-/-) mice. The knockout mice, while maintained on a vitamin A-enriched diet, have reduced (40%) hepatic vitamin A stores but grow and reproduce normally. However, reducing maternal dietary vitamin A to marginal levels during the latter half of gestation results in 100% mortality/litter within 24 h after birth in the CRBP II(-/-) line but no mortality in the wild type line. The neonatal mortality in heterozygote offspring of CRBP II(-/-) dams (79 +/- 21% deaths/litter) was increased as compared with the neonatal mortality in heterozygote offspring of wild type dams (29 +/- 25% deaths per litter, p < 0.05). Maternal CRBP II was localized by immunostaining in the placenta at 18 days postcoitum as well as in the small intestine. These studies suggest that both fetal as well as maternal CRBP II are required to ensure adequate delivery of vitamin A to the developing fetus when dietary vitamin A is limiting.

Animals↗
PubMed1991

Early neonatal mortality and cesarean delivery in Mexico City.

The relationship between cesarean delivery and neonatal mortality is presented with information from 292 early neonatal deaths (cases) and 3098 survivors (controls) born in 25 hospitals in Mexico City during the summer of 1984. The overall rate of cesarean delivery was 27%. Variations between health agencies and different social groups were not related to obstetric risk, suggesting that a sizable proportion of the operations were probably unjustified. Babies of normal birth weight (greater than or equal to 2500 gm) delivered by cesarean section were 2.5 times more likely to die in the early neonatal period compared with vaginally delivered babies of the same weight. The excess of mortality could not be explained by the effect of maternal characteristics or complications or by differences in birth weight or gestational age. It is suggested that the conditions under which the operation was performed probably explain the increased risk of early neonatal death. It is likely that poor quality of resuscitation and respiratory care are implicated in the link between "unnecessary" cesarean section and early neonatal mortality.

Birth Weight↗
PubMed2002

Maternal characteristics associated with place of delivery and neonatal mortality rates among very-low-birthweight infants, Georgia.

To determine whether the Healthy People 2000 objective to deliver very-low-birthweight (VLBW) infants at subspecialty perinatal care centres was met, and if improvements in the regional perinatal care system could reduce neonatal mortality further for 2010, we examined place of delivery for VLBW infants, associated maternal characteristics and the potential impact on neonatal mortality. We used linked birth and death records for the 1994-96 Georgia VLBW (i.e. 500-1499 g) birth cohorts. Among 4770 VLBW infants, 77% were delivered at hospitals providing subspecialty perinatal care. The strongest predictor of birth hospital level was the mother's county of residence, defined using three levels: residence in a county with a subspecialty hospital, residence in a county adjacent to one with such a hospital or residence in a non-adjacent county. Eighty-nine per cent of infants born to women who resided in counties with subspecialty care hospitals delivered at such hospitals, compared with 53% of infants born to women who resided in a non-adjacent county. Women were also more likely to deliver outside subspecialty care if they had less than adequate prenatal care [adjusted odds ratio (AOR) 1.5, P-value = 0.0001]. The neonatal mortality rate varied by level of perinatal care at the birth hospital from 132.1/1000 to 283/1000 live births, with the highest death rate for infants born at hospitals offering the lowest level of care. Assuming that the differences in mortality were due to care level of the birth hospital, potentially 16-23% of neonatal deaths among VLBW infants could have been prevented if 90% of infants born outside subspecialty care were delivered at the recommended level. These findings suggest that a state's support of strong, collaborative, regional perinatal care networks is required to ensure that high-risk women and infants receive optimal health care. Improved access to recommended care levels should further reduce neonatal mortality until interventions are identified to prevent VLBW births.

Adolescent↗
PubMed2005

Neonatal mortality in rural Bangladesh: an exploratory study.

Bangladesh has a neonatal death rate that is substantially high and demands urgent attention. To assess the causes of neonatal mortality, 1,019 pregnant women were followed up in eight randomly-selected rural areas of the country. Trained female interviewers visited the households of the subjects at four-week intervals to record neonatal deaths (within 28 days after birth). For each death, they administered a structured verbal autopsy questionnaire to the mother and/or a close family member. Based on these field data, three neonatologists arrived at a consensus to assign two causes of death--an originating cause and a direct cause. The neonatal mortality rate was 53.5 per 1,000 livebirths. The originating causes of death were pre-maturity/low birth-weight (30%), difficult labour (16%), unhygienic birth practices (16%), others (4%), and unknown (34%). The direct causes were sepsis (32%), asphyxia (26%), tetanus (15%), respiratory distress (6%), others (6%), and unknown (14%). According to the prevailing causes of neonatal deaths, implementation of intervention programmes, often in the community, that do not depend on highly-technical training or sophisticated equipment should be implemented.

Adult↗
PubMed1981

Impact of a regional infant dispatch center on neonatal mortality.

In 1976, a regional Infant Medical Dispatch Center (IMDC) was implemented in Southern California to improve the lives and well-being of the critically ill newborn infants by expediting location of beds in neonatal intensive care units. Comparison of birth weight-specific neonatal mortality rates among 701-2000 grams neonates before and after the program showed a six-fold improvement in hospitals served by the Center over hospitals not served by the Center during the two-year period. From 1975 to 1977, a 43.7 per cent improvement in neonatal mortality among the 701-2000 grams neonates with hyaline membrane disease was observed in the transported infants served by the Infant Medical Dispatch Center as compared to a 22.9 per cent improvement in the group of transported infants not served by IMDC. Both indicators had consistently shown a marked improvement associated with the IMDC program beyond the improvement of medical sciences over the two years. The data suggest that the improved outcome of the neonates referred by IMDC might be related to the improved efficiency of locating available neonatal intensive care beds.

California↗
PubMed2007

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.

OBJECTIVE: To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India. STUDY DESIGN: Before-and-after intervention trial setting: limited resource teaching hospital; DESIGN: Before and after study. INTERVENTIONS: A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses. STATISTICAL METHODS: The categorical and continuous variables were compared with chi (2) and two-tailed tests, respectively. RESULTS: Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P=0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions. CONCLUSIONS: Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.

Hospital Mortality↗
PubMed1996

Neonatal mortality and length of newborn hospital stay.

OBJECTIVE: To investigate the effect of hospital discharge time on neonatal mortality of term newborns. DESIGN: Infants who were discharged home at 5 days of age of younger and who subsequently died were compared with control infants using a retrospective case-control design. Descriptive information was collected from records of infants who were not discharged home from the hospital of birth (because of death or transfer to a tertiary care hospital) to determine the age at which their illnesses presented. METHODS: We reviewed death certificates for all infants with birth weights of 2500 g or greater born at 37 weeks' gestational age or greater who died in the first 28 days of life and who were born in one of four Utah counties (1985 through 1989). Of the 109,256 eligible births, 115 infants were found who had died in the neonatal period. Eighty-four infants had not been discharged home from the hospital of birth, 5 infants had had hospital stays of more than 5 days, 9 records could not be located, 17 presumed healthy infants were discharged from the hospital at 5 days of age or younger. These 17 infants were each matched with 3 control infants. Newborn nursery charts were reviewed to determine hospital discharge times for case and control infants. Descriptive information regarding the time of presentation of illness was collected for the other 89 infants. RESULTS: The mean age of hospital discharge was 43 +/- 21 hours for the 17 case infants and 47 +/- 25 hours for the 51 control infants. The odds ratio for neonatal mortality for discharge at less than 24 hours was 1.65 (95% confidence interval, 0.42 to 3.34) and for discharge at less than 48 hours was 1.16 (95% confidence interval, 0.4 to 3.34). Of the 84 infants who were not discharged home from the hospital of birth, 93% had been symptomatic by 12 hours of age, and 99% were symptomatic by 18 hours. CONCLUSIONS: Most full-term infants who die in the neonatal period are symptomatic within the first 18 hours after birth. We could not demonstrate an association between early hospital discharge and neonatal mortality in those infants who died after discharge home.

Age of Onset↗
PubMed1995

Which birthweight groups contributed most to the overall reduction in the neonatal mortality rate in the United States from 1960 to 1986?

We determined the relative contributions of individual birthweight groups to the reduction in neonatal mortality rate (NMR) of US singleton livebirths from 1960 to 1986, the period during which neonatal intensive care was introduced and became established. Changes in the NMR for each race (non-white/white) and birthweight group were assessed in terms of three components of NMR (1) birthweight-specific neonatal mortality rate (BWS-NMR), (2) birthweight distribution, and (3) the interaction resulting from simultaneous changes in BWS-NMR and birthweight distribution. Overall, NMR decreased from 16.7 per 1000 livebirths in 1960 to 5.5 per 1000 livebirths in 1986. This reduction was achieved mainly by improvements in the BWS-NMRs of all birthweight groups. Neonates who weighted > 1.5 kg at birth were the major contributors to the overall reduction in the NMR; approximately two-thirds of total reduction in NMR between 1960 and 1980 and 52.6% of the total reduction between 1980 and 1986 occurred in the > 1.5 kg birthweight groups. Our study demonstrates that with the introduction of neonatal intensive care, survival of infants with birthweights > 1.5 kg improved markedly and that this improvement accounted for most of the decline in the neonatal mortality rate in the United States from 1960 to 1986. Therefore, in measuring the effectiveness of neonatal intensive care, the assessment should include not only very low birthweight (< 1.5 kg) but all birthweight groups.

Birth Weight↗
PubMed1993

Determinants of neonatal mortality in central Sudan.

A follow-up study was conducted in six community health centres during the period April 1989 to March 1990 to determine the risk factors which influence neonatal survival in central Sudan. The estimated neonatal mortality rate ranged between 20.0 and 36.0 per 1000 live births per year, and the major cause of death was tetanus neonatorum (29% of neonatal deaths). The mortality rate was lowest when tetanus toxoid was received during pregnancy and the umbilical cord was cleaned by a modern hygienic method (mortality rate of 11 per 1000). In contrast, the mortality rate was highest when no tetanus toxoid was received and no or traditional cord cleaning was used (mortality rate of 62 per 1000; relative risk (RR) = 5.6, 95% confidence interval (CI) 2.0-14.9). The major predictors of neonatal mortality were tetanus, short birth-to-conception interval, multiparity, reported malaria during pregnancy, low birthweight, low maternal weight and low socio-economic status. The population attributable risks were high, and the preventable factors collectively accounted for 93.5% of neonatal mortality. Safe deliveries and wider immunization coverage are needed to control neonatal tetanus in this community. Other interventions to lower neonatal mortality in central Sudan should include accessible family planning programmes and measures to lower the incidence of low birthweight.

Birth Weight↗
PubMed2001

Neonatal mortality and maternal health care in Nepal: searching for patterns of association.

This study explores the factors associated with neonatal mortality and maternal health care in Nepal. The subjects were 4375 births reported in the 1996 Nepal Family Health Survey. Maternal and child health care was found to have a significant association with neonatal mortality, although preceding birth interval and sex of child had stronger effects. Four aspects of maternal care were found to be highly associated with region, household ownership of assets, mother's education and father's education. This indicates that accessibility, affordability and availability of maternal health care are important factors to consider in future research on neonatal mortality.

Adolescent↗
PubMedDate not supplied

[Spatial analysis of early neonatal mortality in the municipality of Rio de Janeiro, 1995-1996].

The objective of this study was to establish the spatial distribution of the early neonatal mortality rate (0-3 days) in the municipality of Rio de Janeiro for 1995-1996, identifying the best explanatory factors for spatial variations. By considering Rio de Janeiro's 153 neighborhoods as ecological units of analysis, socioeconomic and maternal indicators were analyzed according to place of residence. Spatial statistical analysis was performed using the Cliff & Ord methodology, appropriate for lattice data. From the 0-3 day mortality thematic map, we clearly identified two clusters of high early neonatal mortality rates. Spatial dependence was also confirmed by the statistical results of the spatial analysis. The variables that explain the clusters are the proportions of "adolescent mothers", "slum-dwellers", and "heads of households below the poverty level". Spatial statistics provided a better understanding of the geographic distribution of early neonatal mortality and suggested potential hypotheses for further investigation, which could support preventive programs and contribute to a decrease in infant mortality.

Adolescent↗
PubMed2005

The influence of mode of delivery on twin neonatal mortality in the US: variance by birth weight discordance.

OBJECTIVE: The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery. STUDY DESIGN: The population-based US "matched multiple birth" database (1995 to 1998) was used to examine the effect of vaginal/vaginal (VV) and cesarean/cesarean (CC) modes of delivery (MOD) on neonatal mortality (<28 days after birth). Births at <32 weeks, congenital malformations, chromosomal anomalies, and discordant MOD (vaginal/cesarean) were excluded. The association between MOD (with CC as the reference) and neonatal mortality was expressed as relative risks (RR) with 95% CI, derived from logistic regression models. RESULTS: The NMR increased with increasing degrees of BWD regardless of mode of delivery. CC was associated with decreased NMR when BWD was between 20% and 40%, but this reached significance at BWD > or =40%; VV pairs had a 1.6-fold (95% CI 1.1-2.2) increased NMR compared with CC. CONCLUSION: In twins with BWD <40%, MOD has no effect on NMR. Beyond or equal to 40% discordance, there was lower NMR with cesarean-cesarean delivery.

Adult↗
PubMed1984

[Perinatal and neonatal mortality and morbidity in central Switzerland in 1982. An analysis of all newborns in a geographically circumscribed region].

In assessment of the perinatal situation in Central Switzerland, all 5616 infants born in the geographically surrounding areas of the Children's Hospital Lucerne have been statistically evaluated, according to birth place, birth weight, gestational age, perinatal condition, and postnatal development. 76 infants (1.4%) were born at home, 417 births (7.5%) took place before the completed 37th gestational week. Only 5.8% of our newborns had weights below the 10th percentile according to the Winterthur percentile curves used in Switzerland. The perinatal mortality was 12.9%, the neonatal mortality 7.1%. 2/3 of the deaths concern either extremely premature babies or infants with severe congenital malformations. The recorded malformations coincide with the known incidence, with the exception of trisomy 21, which marked an incidence of 1:1400. 8% of all live-born babies (499) needed special neonatal care. Among the preterm infants, every 2nd, and among the full-term babies every 12th had to be transferred to the neonatal care unit. Most of the transferrals were due to simple disturbances of adaptation (6% of all live-borns), whereas 1% required intensive care because of severe disorders. In 50 babies (1% of all live-borns), the neonatal diagnosis allows to anticipate a reduction of the quality of life.

Birth Weight↗
PubMed1991

Retarded fetal growth patterns and early neonatal mortality in a Mexico City population.

The study reported here classified 9,660 newborn infants delivered at a maternal and child health center in Mexico City by length of gestation, presence or absence of growth retardation, and (in the case of growth-retarded infants) proportionate or disproportionate growth retardation in terms of the infants' weight and length. It was found that preterm infants (delivered before 38 weeks of gestation) had nine times the early neonatal mortality of term infants, irrespective of growth retardation patterns. Also, the type of fetal growth retardation involved (proportionate or disproportionate) in those cases where such retardation was present was found to have an impact on early neonatal mortality. That is, preterm and term infants classified as having proportionate growth retardation respectively exhibited 1.5 and 9.5 times the early neonatal mortality of preterm and term infants with disproportionate growth retardation. Among other things, these findings suggest a need for assessing types of growth retardation as well as etiologic factors when evaluating mortality risk in newborns.

Classification↗
PubMed2005

Fetal and neonatal mortality risks of multiple births.

The purpose of this article is to describe the perinatal mortality experience and mortality-related risk factors of recent US multiple births. First, we describe trends in fetal and neonatal mortality rates for singleton and multiple births to understand if the improvements in perinatal mortality in the United States are equally or differentially reflected among multiple births. Because the characteristics of women who have multiple deliveries differ from those of mothers of singletons, we describe the risk of fetal and neonatal mortality by maternal characteristics and plurality. Finally, we examine the distribution and fetal and neonatal mortality risk of singleton and multiple births by birth weight and gestational age to provide an updated assessment and contrast of their comparative survival chances within similar birth weight-gestational age categories of intrauterine development.

Adult↗
PubMed2005

Risk factors for neonatal mortality among extremely-low-birth-weight infants.

OBJECTIVE: The purpose of this study was to examine characteristics associated with neonatal mortality among extremely low-birth-weight infants (< or = 1000 g). STUDY DESIGN: A population-based, case-control study using linked Missouri birth and death certificates from 1989 to 1997 was conducted. Cases (n = 835) were defined as extremely low-birth-weight infants that died within 28 days of birth. Controls (n = 907) were randomly selected from extremely low-birth-weight infants that were alive at 1 year and were frequency matched to subjects by birth year and birth weight. RESULTS: Infants born with severe congenital anomalies and at the youngest gestational ages were at greatest risk for neonatal mortality. Other significant risk factors included maternal age (< 18 and > 34 years), vaginal delivery, nontertiary hospital care, malpresentation, male gender, and small for gestational age. Black race and preeclampsia were protective against early death. CONCLUSIONS: The risk of neonatal mortality among extremely low-birth-weight infants was associated with several maternal, infant, and obstetric factors, some of which may be preventable.

Adolescent↗
PubMed1995

[Changes in neonatal mortality and morbidity of very low birth infants in the county of Nordjylland].

The purpose of the study was to investigate changes in neonatal mortality and morbidity in infants with very low birthweight born in the county of northern Jutland, Denmark. The study was retrospective and included infants with birthweight < or = 1500 grams born in northern Jutland. The period 1988-1989 was compared to the period 1990-1993. Two hundred and seventy (270) infants were included. A decrease in neonatal mortality from 27% to 18% was found, and for infants with birthweight < or = 1000 grams the neonatal mortality declined from 60% to 28%. Possible explanations were a higher frequency of betamethasone administration and the introduction of surfactant into routine medical care. The median birthweight declined by just under 100 grams. The frequency of clinically significant periventricular haemorrhage and the frequency of bronchopulmonary dysplasia did not increase. Long-term follow-up is necessary for the evaluation of the final results of the increased neonatal survival.

Denmark↗
PubMed2006

Risk factors for neonatal mortality in rural areas of Bangladesh served by a large NGO programme.

Neonatal deaths account for about half of all deaths among children under 5 years of age in Bangladesh, making prevention a major priority. This paper reports on a study of neonatal deaths in 12 areas of Bangladesh served by a large NGO programme, which had high coverage of reproductive health outreach services and relatively low neonatal mortality in recent years. The study aimed to identify the main factors associated with neonatal mortality in these areas, with a view to developing appropriate strategies for prevention. A case-control design was adopted for collection of data from mothers whose children, born alive in 2003, died within 28 days postpartum (142 cases), or did not (617 controls). Crude and adjusted odds ratios (AOR) were calculated as estimates of relative risk for neonatal death, using 'neighbourhood' controls (241) and 'non-neighbourhood' controls (376). A similar proportion of case and control mothers had received NGO health education and maternal health services. The main risk factors for neonatal death among 122 singleton babies, based on the two sets of controls, were: complications during delivery [AOR, 2.6 (95% CI: 1.5-4.5) and 3.1 (95% CI: 1.8-5.3)], prematurity [AOR, 7.2 (95% CI: 3.6-14.4) and 8.3 (95% CI: 4.2-16.5)], care for a sick neonate from an unlicensed 'traditional healer' [AOR, 2.9 (95% CI 0.9-9.5 and 5.9 (95% CI: 1.3-26.3)], or care not sought at all [AOR, 23.3 (95% CI: 3.9-137.4)]. The strongest predictor of neonatal death was having a previous sibling not vaccinated against measles [AOR, 5.9 (95% CI: 2.2-15.5) and 12.0 (95% CI: 4.5-31.7)]. The findings of this study indicate the need for identification of babies at high risk and early postpartum interventions (40.2% of the deaths occurred within 24 hours of delivery). Relevant strategies include special counselling during pregnancy for mothers with risk characteristics, training birth attendants in resuscitation, immediate postnatal check-up in the home for high-risk babies identified at delivery, advice for mothers on appropriate care-seeking for sick babies, improving the capacity of sub-district hospitals for emergency obstetric and newborn care, and promotion of institutional deliveries.

Adult↗